| NPI | 1801159520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD60634027) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60634027) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2026-03-27 |